What are the recommendations for pain management in patients with a history of opioid abuse?

Updated: Jun 21, 2018
  • Author: David W Dixon, DO; Chief Editor: Glen L Xiong, MD  more...
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Answer

Recommendations include the following:

  • Reassure patients that their addiction histories will not prevent adequate pain management, and discuss plans in a nonjudgmental manner.

  • Verify methadone and buprenorphine doses with clinics or prescribing physicians, and inform these physicians of any benzodiazepines or opioids given that may be detected on urine drug screening.

  • Aggressively treat pain with conventional opioid analgesics. Opioid cross-tolerance often necessitates higher opioid analgesic doses at shorter intervals.

  • Use continuous scheduled dosing orders rather than as-needed orders.

  • For patients receiving methadone maintenance therapy: Continue methadone maintenance dose and add short-acting opioid analgesics.

  • For patients receiving buprenorphine maintenance therapy: Pain management with opioids is complicated by the high affinity of buprenorphine for the mu receptor. This affinity may cause buprenorphine to compete with opioid analgesics at mu receptors. As buprenorphine's rate of dissociation from mu receptors is highly variable, naloxone should be available, and consciousness and respiration should be closely monitored.


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